Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2086S0122X | Plastic and Reconstructive Surgery | 2860 | OK |
NPI | 1114923794 |
---|---|
Provider Name | Dr. Laurie Ann Duckett |
First Address | Tulsa, OK 74104-4431 |
Second Address | Tulsa, OK 74104-4431 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/06/2005 |
Last Update Date | 15/03/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
100136020B | (05) | OK |
G41591 | (02) |